Beat the Clock

Recognize the signs of strokes

By Karen A. Jamrog

Illustration by Stephen Sauer

Without a doubt, the human brain is a biological powerhouse. It weighs the pros and cons of a mortgage deal, enables us to sing along — albeit not necessarily in tune — with the latest Taylor Swift song as we maneuver our car through traffic, and prompts us to laugh at a Bugs Bunny cartoon as we feel good sitting next to a favorite someone, all while working seamlessly behind the scenes to keep us alive.But a glitch in the blood flow to the brain creates a virtual power interruption to the supercomputer of the body. This is what happens when a stroke occurs; a blood vessel leading to the brain becomes blocked or bursts, interfering with the brain’s oxygen- and nutrient-carrying blood supply. In its wake, a stroke can leave brain damage that cripples a person’s ability to walk, talk, and perform basic self-care tasks.

Strokes are a leading cause of death and disability in the United States, affecting more than 795,000 people each year, according to the Centers for Disease Control and Prevention. During ischemic strokes, which account for more than 80 percent of all strokes, blood flow to the brain is interrupted by an obstruction that results from gradual clot build-up in an area of the brain, or happens suddenly when a chunk of a blood clot located in another part of the body breaks off, “floats downstream, and basically clogs the pipe and the blood flow,” says Carl M. Fier, MD, FACC, chief of cardiology at Elliot Hospital in Manchester. Another major category of stroke is called “hemorrhagic,” and occurs when blood escapes through a ruptured or damaged blood vessel, leaking into the surrounding area and creating pressure on the brain.

Regardless of the type of stroke, swift detection and treatment are crucial. Just as you should immediately seek medical attention if you experience heart attack symptoms, experts say, you should dial 911 upon seeing the first signs of a stroke. “The critical window of time from when there’s symptom onset to when we can really do something aggressive to almost potentially completely [reverse] the effects of stroke is only about four hours,” Fier says.

Stroke patients who receive care quickly have an opportunity to receive tPA, a powerful clot-busting medication. Of course, there are no guarantees even for early arrivals to the ER. But “the brain is usually pretty tolerant within that timeframe of about three to four hours,” Fier says, so that even if blood flow has completely stopped, there’s still a chance that doctors “can almost completely negate the effects of stroke,” he says. Unfortunately, most current data shows that the median time lapse between symptom onset and emergency room arrival is 12 to 13 hours, far beyond the optimum treatment window.

For ischemic stroke victims, other treatment methods include mechanical methods to physically remove a clot. If a patient is experiencing a hemorrhagic type of stroke, the first order of business is usually to ensure that bleeding has stopped, followed by controlling any brain swelling. In some instances, doctors need to create openings in the skull in order to relieve the pressure, Fier says.

Some Granite State hospitals also bring in outside expertise for treatment of stroke patients, using phone, video, and the like to connect local doctors with stroke neurologists in Boston. A telemedicine partnership is “certainly a great option,” Fier says. “There aren’t a lot of stroke neurologists, and there’s a lot of patients that have stroke because it’s such a prevalent condition, so this is a great way to use technology, to sort of get the doctors to the patient rather than the other way around.”

After the initial crisis is over, many stroke patients begin a rehabilitation program, where they receive help with swallowing, speaking and re-learning how to walk. “The majority of people who have a stroke don’t fully recover,” says Fier. It’s a frustrating reality that many stroke patients face long-term consequences that might have been avoided if they’d sought medical attention sooner. “We have the tools right here to take care of them,” Fier says. “The problem is, it’s the rare patient that gets to us within that four-hour window that’s really critical.”

Knowledge is power, so know the signs. Symptoms of a stroke can vary even within the same person on different occasions, but typically an abrupt change is involved, such as sudden numbness or weakness in a leg, arm or side of the face, or sudden confusion or trouble understanding what people are saying, says Tracey Collins, MSN, CNRN, director of professional development and stroke program coordinator at Portsmouth Regional Hospital. Difficulty walking, dizziness or loss of balance can also be warning signs, as can a severe headache in an individual who doesn’t normally have migraines or headaches. The key is to note the sudden onset of symptoms, rather than a gradual change that might result from, say, Alzheimer’s disease or advancing age, Collins says.

Prevention

Some factors that increase the likelihood of stroke, such as age and some heart rhythm abnormalities, are not within a patient’s control. But individuals can take steps to lessen their overall risk of stroke by maintaining blood vessel and blood pressure health, Fier says. Keep vascular disease at bay by striving for a cholesterol number that is within the ideal range, and do not smoke, which is “by far” one of the top controllable risk factors for stroke and vascular disease, Fier says. Also, be mindful of other mainstays of good cardiovascular health, such as regular exercise, weight control and stress reduction.

In addition, don’t neglect to follow your doctor’s orders, says Collins. If your doctor prescribes medicine for you, for instance, tells you to get your blood pressure under control or instructs you to take daily aspirin, then do it, she says. Likewise, if you have diabetes — another big player in stroke-related risk — don’t be too casual about your blood sugar. “A lot of times we hear of [stroke patients] who stopped taking their medication, didn’t take care of their blood pressure or didn’t watch their blood sugars,” she says.

If you see signs of stroke, don’t delay

Like a heart attack, prompt treatment for a stroke can be life-saving, so know the signs. Tracey Collins, MSN, CNRN, director of professional development and stroke program coordinator at Portsmouth Regional Hospital, says that stroke symptoms include the
sudden onset of:

numbness or weakness of face, arm or leg, especially on one side of the body

confusion, trouble speaking or understanding

difficulty walking, dizziness, loss of balance or coordination

severe headache with no known cause

This article appears in the April 2013 issue of New Hampshire Magazine